title: Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial.
abstract: OBJECTIVE
  Invasive procedures such as surgery cause immunosuppression, leading to increased risk of complications, infections and extended hospital stay. Emerging research around immune-enhancing nutrition supplements and their ability to reduce postoperative complications and reduce treatment costs is promising. This randomised controlled trial aims to examine the effect of preoperative immunonutrition supplementation on length of hospital stay (LOS), complications and treatment costs in both well-nourished and malnourished gastrointestinal surgery patients.
  
  
  METHODS
  Ninety-five patients undergoing elective upper and lower gastrointestinal surgery were recruited. The treatment group (n=46) received a commercial immuno-enhancing supplement 5 days preoperatively. The control group (n=49) received no supplements. The primary outcome measure was LOS, and secondary outcome measures included complications and cost.
  
  
  RESULTS
  A nonsignificant trend towards a shorter LOS within the treatment group was observed (7.1 ± 4.1 compared with 8.8 ± 6.5 days; P=0.11). For malnourished patients, this trend was greater with hospital stay reduced by 4 days (8.3 ± 3.5 vs 12.3 ± 9.5 days; P=0.21). Complications and unplanned intensive care admission rates were very low in both the groups. The average admission cost was reduced by AUD1576 in the treatment group compared with the control group (P=0.37).
  
  
  CONCLUSIONS
  Preoperative immunonutrition therapy in gastrointestinal surgery has the potential to reduce the LOS and cost, with greater treatment benefit seen in malnourished patients; however, there is a need for additional research with greater patient numbers.
authors.affiliation: Nutrition Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia. labar@deakin.edu.au
authors.forename: L A
authors.initials: LA
authors.lastname: Barker
authors.forename: C
authors.initials: C
authors.lastname: Gray
authors.forename: L
authors.initials: L
authors.lastname: Wilson
authors.forename: B N J
authors.initials: BN
authors.lastname: Thomson
authors.forename: S
authors.initials: S
authors.lastname: Shedda
authors.forename: T C
authors.initials: TC
authors.lastname: Crowe
mesh_terms: D000368:Aged; D003422:Critical Care / Q000191:economics; D019587:Dietary Supplements; D013505:Digestive System Surgical Procedures / Q000191:economics; D017558:Elective Surgical Procedures / Q000191:economics; D005260:Female; D005526:Food, Formulated; D041981:Gastrointestinal Tract / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000178:diet therapy / Q000276:immunology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D012016:Reference Values